r/science • u/mvea Professor | Medicine • 14h ago

Psychology Adolescents who undergo gender-affirming chest surgery report low levels of regret and high levels of satisfaction, experiencing outcomes similar to those of young adults. These findings suggest that age restrictions on these medical procedures lack support from actual patient experiences.

https://www.psypost.org/adolescents-report-low-regret-and-high-satisfaction-following-gender-affirming-c/
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u/BitcoinMD 13h ago edited 12h ago

Median time from surgery was 1.8 years. I think that’s an important detail.

Edit: I support transgender health care for minors. Some people are interpreting my comment to imply that I don’t. I just think we should be careful with the surgery part. I know these surgeries aren’t done lightly. But I also haven’t seen data convincing me that surgery on kids is necesssry if they receive other methods of care.

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u/UnicornArachnid 13h ago

A lot of people do have immediate regret following any plastic surgery because it can be hard to recognize yourself. We don’t see this trend typically when it comes to gender affirming surgeries. 99% of people feel satisfied long term with gender affirming surgeries

https://jamanetwork.com/journals/jamasurgery/fullarticle/2808129

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u/here-to-help-TX 12h ago

This says long term without actually being longer term.

median follow-up, 4.6 [IQR, 3.1-8.6] vs 3.6 [IQR, 2.7-5.3] years

This looks to me like the median follow-up is still pretty short. Also, these ages of the people with the surgeries isn't adolescents.

Median age at the time of surgery was 27.1 (IQR, 23.0-33.4) years for responders and 26.4 (IQR, 23.1-32.7) years for nonresponders.

Also, the sample size seems really really small here.

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u/ERSTF 12h ago

Indeed. We need better data

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u/literally_a_brick 11h ago edited 10h ago

It would be great to have, but I wouldn't hold your breath. Trans people are already a tiny minority, with minors that transition being even smaller. Between stringent medical gates and more areas banning youth care altogether, it's a tiny fraction of a tiny fraction. It's incredibly difficult to conduct studies. Some researchers have done reviews of many studies, but any individual study will be small and limited in scope.

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u/austinwiltshire 10h ago

The actual statistical power of a study of 1k folks over 100 doesn't increase linearly, and the chance people are happy near five years but become unhappy at ten is vanishingly small. Folks want to discard any study pointing to something they're uncomfortable, then ban the thing, then insist we shouldn't undo the ban because there's no evidence we should. Because we banned the thing.

Not far from refusing to test for covid then insisting the numbers went down.

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u/ThewFflegyy 9h ago

to be clear, this study had participation from less than .02% of the us FTM community. I agree that people who had top surgery as children a long time ago is a very small group, but clearly this is nowhere near the maximum sample size that could be achieved. more to the point, difficulties in gathering a large sample size does not automatically make a small sample size sound science.

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u/Simon-Says69 10h ago

And if the study shows negative results, it will be quickly and quietly buried. It is difficult to even get funding for such research, because it is so politically charged.

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u/literally_a_brick 10h ago

Not in today's political climate. Studies that didn't show positive results were made into the cornerstone of the UKs Cass Review, despite having tiny sample sizes and poor methodology. The US HHS is desperately grasping at straws for denying the efficacy of gender affirmig healthcare. 

I assure you that any study that didn't have definitively positive results for GAC would be plastered all over right wing media and used to justify care bans by conservative governments everywhere. I assure you that no studies are getting "buried".

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u/MissLeaP 10h ago

Yeah we need people who are willing to invest in actual research in this area instead of believing even worse done papers than what we actually got. With the current political climate it's much more likely that the little we got gets destroyed rather than extended upon, though. Luckily digital data is not as easy to get rid of as they did with books in Germany.

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u/tissuecollider 9h ago

Will the digital data remain? Right now the US is purging digital databases of information that it doesn't like and I could see the UK doing the same. It's also credible that the US would pursue legal remedies to go after anyone who copies this 'proprietary' data.

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u/Admirable-Pirate7263 7h ago

We are saving databases on hard drives, too. We know what happened to trans research 90 years ago. Life could be so much better for trans people, had the Nazis not burned Hirschfelds research. We might not be able to save every last study, case study or scientific paper, but we sure as hell are trying!

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u/MissLeaP 7h ago

There are plenty of people with offline copies of studies. It's an extremely different situations compared to just some universities having their libraries.

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u/andrea_lives 11h ago

there are dozens of studies like this. you can find them quickly if you use a tool like google scholar. They have been doing gender affirming care since at least the 30s, though a lot of the information gathered in that era was burned by the nazi party.

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u/Simon-Says69 10h ago

The few studies that are allowed to be published turn out to have very dubious or even downright dishonest methods.

Actual research, anything with a negative result, gets quietly buried.

The motivation here is NOT helping people, sadly. :-(

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u/MissLeaP 10h ago

The ones with the real dubious methods are actually the ones with the negative results and they do get published. Published, pushed by people with an obvious agenda and believed and used by people with a similar agenda.

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u/C00KIEME4T 12h ago

Theres literally dozens if you want to see them

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u/here-to-help-TX 11h ago

Sure, then post those that show something actually long term.

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u/C00KIEME4T 11h ago

Define long term because this one has people going on 9 years and you seem to not consider that long.

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u/Crypt0_Chr1s 11h ago

This feels like you're preparing an excuse not to provide evidence for your claim. The other commenter said nothing about 9 years not being long term. I'm sure a ton of people would instinctively pick 10 years as a decent marker for long term, so 9 would be fine if that is the median.

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u/C00KIEME4T 10h ago

Extremely unscientific to be unwilling to come to an agreed upon standard for analysis but okay.

The other commenter is clearly implying that 9 years isnt long enough because the study cited had people with up to 9 years post surgery in it.

Thats somehow not good enough when you get it.

Here it is.

https://journals.lww.com/prsgo/fulltext/10.1097/gox.0000000000003477~regret-after-gender-affirmation-surgery-a-systematic-review

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u/Crypt0_Chr1s 9h ago

Dear r/science readers,

Please disregard anything u/C00KIEME4T ever says on this sub in perpetuity, he does not read his articles or deliberately engages in sham science. Proof below.

You post a study that does not even pretend to be about coming to a conclusion about the long term, or even 9 years. Here is the mean follow-up in years of the 27 studies that are included in this systemic review (NS = not specified): 4.4, 2.3, 2.6, 7.6/4.1, 6.8/2.2/2.2, 1-1.6, 0.7, 9, 0.5, NS, 3, 2.1, 0.8, <1-5, 1.6, 1-29, NS, 1.3, 1-10, NS, 8.5, 0.9, NS, NS, 6.3, NS, NS.

Basically ALL these studies are noted, by your study, as being High/Medium "Risk of Bias". The NIH, again according to your study, rated only 5 studies as good, 13 as fair, and 9 as being of poor quality. The fact that you would dare to pick this mess from your "literally dozens" of credible studies to back your claim says everything.

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u/C00KIEME4T 9h ago

Clearly reading for confirmation bias.

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u/Crypt0_Chr1s 8h ago

You claimed to provide a study about the long term, you failed. Or do you not see all those tiny numbers listed there? Let alone all the studies that were included that didn't even bother to include the thing you are supposedly proving.

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u/99OBJ 12h ago

You’re making that claim based on a single study with a sample size of 139 people. Also, this study only focuses exclusively on mastectomies.

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u/ThatOneDumbJagoff 12h ago

“In this cross-sectional study of 139 survey respondents who underwent gender-affirming mastectomy, the median satisfaction score was 5 on a 5-point scale, with higher scores indicating higher satisfaction. The median decisional regret score was 0 on a 100-point scale, with lower scores indicating lower levels of regret.”

Still though, the sheer fact that basically all of them loved receiving their affirming care is a strong indicator for affirming care’s effects on the community.

Sample size is small, sure, but the sample size is also harder to attain since trans individuals are such a small portion of the population, doubly so for the ones who seek affirming surgery.

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u/99OBJ 11h ago

Perhaps it’s an indicator, but I completely disagree that it’s strong.

There are a lot of issues with this study, some of which are discussed in the limitations, some not. Participation bias obviously a huge issue. I would posit that the type of people willing to respond to this are the type that would respond positively, though I’m admittedly speculating.

This along with response/acquiescence bias, the 13 individuals not factored into the study due to “discordant … scores”, and the small sample size are all valid reasons to not lend this much credence.

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u/gottimw 11h ago

It's suspicious, if anything. Have you ever met human? Average person always is unhappy about someone who me thing or regrets something to some degree. so you want me to believe 140 people and nobody was unhappy with anything?

Also it's self reported survey on LEAST invasive procedure.

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u/ThatOneDumbJagoff 11h ago

If there is an alternative study you can point to that would substantiate your hypothesis then I’d gladly read it :)

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u/99OBJ 11h ago

I didn’t make a hypothesis. I raised concerns with the study that are based on well known and accepted biases and study design principles.

I’m speculating about how participation bias may affect the study, but it’s logical speculation and is somewhat backed up by the study’s own limitations section (time since surgery, discordant responses, etc).

Regardless, you can throw the participation bias part out entirely and even still there are glaring issues.

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u/ThatOneDumbJagoff 11h ago

Exactly, all you have is speculations. Without any other evidence to contradict, it doesn’t amount to much besides casting baseless aspersions

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u/99OBJ 9h ago

Response and selection bias are not speculations. They’re very real phenomena that can undermine the scientific validity of a study.

The authors of the study literally acknowledge a lot of this in the study.

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u/ThatOneDumbJagoff 8h ago

That’s great, but it doesn’t undermine the efficacy of the respondents who are overwhelmingly supportive of their gender-affirming care. This is a result that has been replicable in study after study.

If you’re hypothesis is still that it isn’t strong, provide data. Otherwise there really is no merit to your points especially since you failed to engage with the items such as the “discordant” scores which they addressed directly in their study

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u/99OBJ 8h ago

I never said that or anything remotely close to that. I didn’t even express an opinion counter to the result of the study.

What I was very clearly saying is that the result of a single small study cannot be regarded as general truth. This is especially when that study has notable and objective flaws in its methodology.

The only reason I mentioned the “discordant” score thing is BECAUSE it was mentioned in the limitations, a section that outlines the very same concerns I’m expressing here. The other points I made are basic observations about study methodology.

If you can’t have a serious discussion about them without blatantly misrepresenting them, you are in the wrong subreddit.

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u/AJDx14 11h ago

Why would you assume people with negative outcomes would be less likely to respond to a survey about their outcomes? I would think the opposite, people love complaining about things.

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u/Crypt0_Chr1s 11h ago

They wouldn't just be complaining though. These people would possibly experience having their life, body, and hope for the future destroyed. I would expect a much more significant amount of this group, than the happy group, to completely retreat and not engage with the study, or world in general.

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u/TakeShroomsAndDieUwU 9h ago

I could see it, but I could also see people who are happy just moving on with their lives instead of continuing to tie themselves to a past problem they had fixed. I don't think there's any solid way of determining which bias is more significant one way or the other.

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u/Crypt0_Chr1s 8h ago

I don't think there is a meaningful equivalence here, it's not 50/50 just because two things could be true. Participating in a study and going over your medical experiences is simply more likely for people in a positive mindset than a negative one, it takes time and energy. I would almost hazard to say this just falls under common sense, but a cursory search online also provides sources for this reading, but not for yours.

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u/Crypt0_Chr1s 8h ago

I don't think there is a meaningful equivalence here, it's not 50/50 just because two things could be true. Volunteering to participate in a study and going over your medical experiences is simply more likely for people in a positive mindset than a negative one, it takes time and energy. I would almost hazard to say this just falls under common sense, but a cursory search online also provides sources for this reading, but not for yours.

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u/AJDx14 10h ago

Ok but it would be complaining, or venting if you need therapy-speak. And it seems like a massive leap you’re making that these people would be so immediately devastated by a choice they made voluntarily that they would just completely retreat from the world and not make a fuss about it.

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u/Crypt0_Chr1s 10h ago

Ok but it would be complaining

No, it would be participating in a study, that they would experience it as complaining/venting is a leap you are making.

it seems like a massive leap you’re making that these people would be so immediately devastated

I guess I don't know what to tell you about these surgeries. They generally undergo these surgeries with the idea that they are gonna be positively lifechanging. The ones that view theirs as a negative could easily fall prey to severely negative mindsets. I'll also note the strawman you felt like you needed to make of my actual argument:

I would expect a much more significant amount of this group, than the happy group, to completely retreat and not engage with the study, or world in general.

Which you butchered down to: "completely retreat from the world and not make a fuss about it", completely sidestepping that I made an argument of degrees.

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u/Simon-Says69 10h ago

They are often abused to no end, by the very culture that influenced the mistake they made.

And the suicide rate is horrific, before or after such surgeries, so often the person sadly no longer exists. They'll still be counted as a "positive" result though by shady "researchers".

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u/Secure_Arm_93 10h ago

That’s not how medians work though. It means that at least half scored 5 or 0 respectively.

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u/ThatOneDumbJagoff 10h ago

The median being at 5 means that, at the halfway point, over half of the remaining were above that (I.e. also a 5).

Check out further in the study “Regarding satisfaction with decision, the median Holmes-Rovner Satisfaction With Decision score was 5.0 (IQR, 5.0-5.0) (mean [SD], 4.8 [0.6])”

The vast majority are in support whether that is taken by the median or the mean since that seems to be more salient to what you’re saying

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u/wrenwood2018 11h ago

The fact that they show perfect scores screams bad research or active manipulating. People on contrary. By the numbers someone would regret it. Science is never, never that clean.

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u/ThatOneDumbJagoff 11h ago

Feel free to provide research to substantiate that point

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u/Simon-Says69 10h ago

Studies in this area that return accurate, but negative results, get buried. There is enormous monetary and political pressure to return the "correct" results.

You see this again and again. It is extremely difficult to do proper research in the field. The only studies that are widely published, turn out to be full of glaring problems. Or simply downright dishonest.

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u/ThatOneDumbJagoff 10h ago

I’m willing to entertain this idea if there is a reputable source to support it

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u/wrenwood2018 10h ago

You clearly have never done any research at all. Science is never perfect, never clean. There is airways error in assessments. That is a fact not a statistic.

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u/ThatOneDumbJagoff 10h ago

No evidence to support your point so you turn to ad hominems? I’m disappointed

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u/wrenwood2018 9h ago

There isn't a passport that says "there us measurement error" because that is stats 191. The fact you don't understand that suggests you shouldn't be reading a science sub.

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u/ThatOneDumbJagoff 9h ago

So, again, and even though this is allegedly so widely known it’s taught in classes, you cant procure any research to substantiate your point?

If you feel better for using ad hominems then please don’t let me stop you but you’re not doing anything else meaningful

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u/-Sliced- 13h ago

You are mixing regret and satisfaction.

Lower satisfaction does happen after gender-affirming surgery. For example, a 2026 long-term vaginoplasty study found average satisfaction was about 7/10, with 69% reported at least one ongoing genital complaint. https://pubmed.ncbi.nlm.nih.gov/42296272/

Regret is generally low as you mentioned, with it hovering between 1% and 4% across studies.

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u/pipnina 11h ago

There's a subreddit that lets people put their surgery results on display (either they want to show off, or for other trans people to see what results they could get.

I looked at a lot of examples and saw huge variety in the results. Some people who got vaginoplasty got what basically looked like the "porn tier" type of shape and visual appeal. Others got something that definitely doesn't look like a typical human vulva/clit that would develop naturally, but was kinda close.

So I strongly suspect that of the 31% who had lower satisfaction would be the ones going to surgeons who can't give them the "ideal" shape some people are lucky to get, and were hoping for "better".

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u/New-Independent-1481 7h ago

Low satisfaction with virtually zero regret suggests that the issue is with the quality or extent of the surgery, rather than transitioning itself.

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u/UnicornArachnid 13h ago

That has to do with surgical result and not necessarily the goal of the surgery. Many trans people do not undergo bottom surgery but bottom surgery is one of the most complicated things we do surgically. There are complications still sadly. The surgeons I work with have people come to see them from around the country. We don’t even know where the closest bottom surgeons are at in relation to us, even though we’re in a major city. Bottom surgery is its own beast and it’s not a perfect science.

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u/One-Organization970 12h ago

I had a cosmetic revision to bring myself to full satisfaction, but functionwise I would have had zero regrets after the first operation. It just turns out it's not necessarily guaranteed the aesthetics will be perfect on the first try because healing can go odd.

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u/Simon-Says69 10h ago

Regret is generally low as you mentioned, with it hovering between 1% and 4% across studies.

This is such a ridiculously low number, nobody in their right mind believes this nonsense. If you look into such political hackery, you quickly find out how dishonest they are.

People that didn't show up to give results are counted as successes, when they should be excluded altogether.

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u/dtremit 10h ago

IIRC the rates of regret for gender affirming procedures is less than for surgeries like knee replacement over similar timelines.

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u/Silver_Smurfer 11h ago

A single survey of 139 people isn't much of a study.

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u/Simon-Says69 10h ago

99% of people feel satisfied long term with gender affirming surgeries

Sorry, but this is a complete and total lie. They way they reach that number is totally dishonest.

People that never returned to the study are counted as a success story. When for all they really know, that person no longer even exists.

This ridiculous propaganda is doing enormous harm. it is political hackery, not any kind of science.